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in washington post regarding medical costs and they have for example appendectomy costs $13,000 but in germany, 3,100, you would think that you would think it is government run so is subsidized but yet they spend 11% of gnp while we spend 17.5%. how do you explain the discrepancy? >> guest: great question. they have a somewhat controlled system over there which i have no doubt has good outcomes knowing germans fidelity to quality and engineering and expectations, we don't have competition. if you read marty makary's book he will find out the reasons why things cost. often times one of the points he makes, we often have physicians with great reputations who all the doctors know are the worst doctors so the question is about having transparency. the third thing is they don't have the court system we have which is tremendously expensive. in my last few years of practice it was costing me $1,000 or $2,000 a day in terms of malpractice costs for baby. that was fully absorber cost so they don't have that, they don't have the rules and regulations we have. there's a lot to be said about what the germ
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